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“We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland)
BACKGROUND: Reactive focal mass drug administration (rfMDA), or presumptive treatment without malaria testing of household members and neighbours of a passively identified malaria case, is currently being explored as a possible malaria elimination strategy in low transmission settings. One of the pr...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631448/ https://www.ncbi.nlm.nih.gov/pubmed/31307494 http://dx.doi.org/10.1186/s12936-019-2877-9 |
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author | Baltzell, Kimberly A. Maglior, Alysse Bangu, Khaya Mngadi, Nontokozo Prach, Lisa M. Whittemore, Brooke Ntshalintshali, Nyasatu Saini, Manik Dlamini, Nomcebo Kunene, Simon Hsiang, Michelle S. |
author_facet | Baltzell, Kimberly A. Maglior, Alysse Bangu, Khaya Mngadi, Nontokozo Prach, Lisa M. Whittemore, Brooke Ntshalintshali, Nyasatu Saini, Manik Dlamini, Nomcebo Kunene, Simon Hsiang, Michelle S. |
author_sort | Baltzell, Kimberly A. |
collection | PubMed |
description | BACKGROUND: Reactive focal mass drug administration (rfMDA), or presumptive treatment without malaria testing of household members and neighbours of a passively identified malaria case, is currently being explored as a possible malaria elimination strategy in low transmission settings. One of the primary factors determining the effectiveness of rfMDA on reducing or interrupting transmission is achieving high coverage of the target population with drug administration. This study aims to explore the acceptability of rfMDA and identify facilitators and barriers to its potential implementation, as well as the community’s general knowledge, attitudes and beliefs with regard to malaria elimination. METHODS: A qualitative study was performed using focus group discussions (FGDs) among villagers that received rfMDA through the National Malaria Control Programme in the low transmission setting of Eswatini as part of a 2-year clinical trial. FGDs were audio-recorded, transcribed and translated into English. All transcripts were managed in Dedoose and underwent qualitative content analysis. RESULTS: The majority of participants perceived their community to be at high risk of malaria. Witnessing others in their community suffer from malaria, proximity to Mozambique, various ecological factors, and the presence of mosquitoes contributed to this perception. The greatest motivator of participation in rfMDA was witnessing someone else suffer from malaria, since most participants had not personally experienced malaria themselves. Participants valued the education on rfMDA and on malaria in general, particularly when communicated by nurses and other health workers from the Ministry of Health. Participants were overwhelmingly motivated to participate in rfMDA in order to obtain protection from malaria. Most participants did not understand the concept of sub-clinical infection and, therefore, did not perceive the anti-malarial medication given in rfMDA to be a treatment medication. CONCLUSIONS: Perceived risk for malaria was a major driver of acceptability; therefore, future intervention campaigns could aim to better quantify risk to inform interventions and encourage uptake. There were misunderstandings about the asymptomatic reservoir of parasites in humans. Given that this phenomenon is the rationale for rfMDA, this misunderstanding could threaten the uptake of the intervention if it persists in the community. Using local authorities to deliver messaging, additional education on this concept with re-inforcement that risk of malaria is ongoing, even in the absence of frequent cases, may help to maximize and maintain acceptability. |
format | Online Article Text |
id | pubmed-6631448 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66314482019-07-24 “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) Baltzell, Kimberly A. Maglior, Alysse Bangu, Khaya Mngadi, Nontokozo Prach, Lisa M. Whittemore, Brooke Ntshalintshali, Nyasatu Saini, Manik Dlamini, Nomcebo Kunene, Simon Hsiang, Michelle S. Malar J Research BACKGROUND: Reactive focal mass drug administration (rfMDA), or presumptive treatment without malaria testing of household members and neighbours of a passively identified malaria case, is currently being explored as a possible malaria elimination strategy in low transmission settings. One of the primary factors determining the effectiveness of rfMDA on reducing or interrupting transmission is achieving high coverage of the target population with drug administration. This study aims to explore the acceptability of rfMDA and identify facilitators and barriers to its potential implementation, as well as the community’s general knowledge, attitudes and beliefs with regard to malaria elimination. METHODS: A qualitative study was performed using focus group discussions (FGDs) among villagers that received rfMDA through the National Malaria Control Programme in the low transmission setting of Eswatini as part of a 2-year clinical trial. FGDs were audio-recorded, transcribed and translated into English. All transcripts were managed in Dedoose and underwent qualitative content analysis. RESULTS: The majority of participants perceived their community to be at high risk of malaria. Witnessing others in their community suffer from malaria, proximity to Mozambique, various ecological factors, and the presence of mosquitoes contributed to this perception. The greatest motivator of participation in rfMDA was witnessing someone else suffer from malaria, since most participants had not personally experienced malaria themselves. Participants valued the education on rfMDA and on malaria in general, particularly when communicated by nurses and other health workers from the Ministry of Health. Participants were overwhelmingly motivated to participate in rfMDA in order to obtain protection from malaria. Most participants did not understand the concept of sub-clinical infection and, therefore, did not perceive the anti-malarial medication given in rfMDA to be a treatment medication. CONCLUSIONS: Perceived risk for malaria was a major driver of acceptability; therefore, future intervention campaigns could aim to better quantify risk to inform interventions and encourage uptake. There were misunderstandings about the asymptomatic reservoir of parasites in humans. Given that this phenomenon is the rationale for rfMDA, this misunderstanding could threaten the uptake of the intervention if it persists in the community. Using local authorities to deliver messaging, additional education on this concept with re-inforcement that risk of malaria is ongoing, even in the absence of frequent cases, may help to maximize and maintain acceptability. BioMed Central 2019-07-15 /pmc/articles/PMC6631448/ /pubmed/31307494 http://dx.doi.org/10.1186/s12936-019-2877-9 Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Baltzell, Kimberly A. Maglior, Alysse Bangu, Khaya Mngadi, Nontokozo Prach, Lisa M. Whittemore, Brooke Ntshalintshali, Nyasatu Saini, Manik Dlamini, Nomcebo Kunene, Simon Hsiang, Michelle S. “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) |
title | “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) |
title_full | “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) |
title_fullStr | “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) |
title_full_unstemmed | “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) |
title_short | “We were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in Eswatini (formerly Swaziland) |
title_sort | “we were afraid of the lion that has roared next to us”; community response to reactive focal mass drug administration for malaria in eswatini (formerly swaziland) |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631448/ https://www.ncbi.nlm.nih.gov/pubmed/31307494 http://dx.doi.org/10.1186/s12936-019-2877-9 |
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